Swallowing disorders in severe brain injury in the arousal stage
Dr Amélie BREMAREa, Dr Amandine RAPINb, Prof Benoît VEBERc, Prof Françoise BEURET BLANQUARTc, Prof Eric VERINb
a Centre Médical et Pédagogique pour Adolescents, b Centre Régional de Médecine Physique et de Réadaptation Les Herbiers, c CHU Hôpital Charles Nicolle
Introduction: Swallowing disorders are frequent after acquired brain injury and could be at risk of severe impairments, especially aspiration pneumonia.
Objective: To determine the clinical characteristics of swallowing disorders after severe brain injury in the arousal stage after coma.
Method: The patients were included prospectively and consecutively, between December 1st 2013 and June 30th2014 for rehabilitation after a severe acquired brain injury,which motivated an admission in intensive care unit. Patients didn't report swallowing disorders before the recent brain injury. Socio-demographic data and initial general clinics were collected. The evaluation of swallowing included an oriented clinical examination, a functional swallowing test, and a nasofibroscopy with per endoscopic swallowing test. The possibility of oral feeding and the occurrence of complications related to swallowing disorders (weight loss or bronchopulmonary infection) were collected.
Results: Of the 13 patients admitted, 11 were included and 9 (81.8%) were male. The mean age was 40.7+/-14.6 years. All patients had swallowing disorders at admission. The first functional swallowing test showed a disorder of transport of the food bolus whether oral (77.8%) and pharyngeal (66.7%) leading with the compote consistency, while alterations of airways protective mechanisms predominated with the sparkling fluid consistency (80% of tested patients).The swallowing test under endoscopic control highlighted, regardless of consistency, a disorder of the coordination of swallowing, mostly importantly, in 55.6% of patients tested. Seven (63.6%) of patients resumed oral feeding within an average of 6 weeks after admission and 14 weeks after acquired brain injury, with continued need for solid and liquid textures suitable for 6 (85.7%) of them. It did not occur complications related to swallowing disorders during the study.
Conclusion: Swallowing disorders are systematic in severe brain injury in the arousal stage. Early bedside assessment of swallowing is essential to detect and propose a rehabilitative medical care appropriate to these patients in a state of altered consciousness.
Keywords : Swallowing disorders ; disorders of consciousness ; severe acquired brain injury